Spontaneous resolution of maternal hydramnios in congenital cystic adenomatoid malformation of the lung. Antenatal ultrasound features

Case report A 32-year-old patient with two normal children was pregnant for the third time. She was booked for delivery in Boston, Lincolnshire, but was transferred to Nottingham City Hospital (because it has neonatal surgical facilities) with acute polyhydramnios and a threatened premature labour at 30 weeks gestation. Polyhydramnios had been diagnosed 2 weeks previously and an Xray taken in Boston showed no obvious evidence of fetal abnormality. On admission she had been on a ritodrine infusion for 24 h. Her pulse was 120, blood pressure 110/70 mmHg and her temperature 37.6OC. The uterus was enlarged to the size of a full term pregnancy, fetal parts could not be felt and there was gross polyhydramnios. The cervix was 0.5 cm in length and 2 cm dilated. The membranes were bulging. The fetal parts could not be felt, and on vaginal examination they floated away from the examining fingers. After 4 h observation, the ritodrine drip was discontinued because of increasing maternal distress. Her pulse was 156. This action was taken after discussion with both parents in view of the likelihood of fetal abnormality and the risk of continuing ritodrine infusion in the presence of acute hydramnios. The patient was sedated with pethidine (75 mg) and Phenergan (25 mg). Gradually her pain settled down and her general condition improved. The following morning her temperature was 38.OoC, she had blood and protein in the urine and she was found to have a urinary tract infection. This was successfully